King: Why the Affordable Care Act was a bad idea

By Bill King

Updated 3:32 pm, Wednesday, July 4, 2012

I am taking a break from our discussion about population trends to make a few observations about the Affordable Care Act and the Supreme Court's decision last week to uphold most of it. I know it is hard to imagine that anything new can be said on the subject, but fools rush in …"

Since the ACA was originally passed, I have been asked many times about my opinion about the merits of act. My answer has always been the same. I have no idea.

The law is 2,700 pages long and I have not devoted the time to read the entire bill, much less done any kind of detailed analysis. Second, even if I had the time and inclination to study the law, I do not have the expertise in the health care industry to understand it. Third, even if a person has the time, inclination and expertise, there is no way anyone can anticipate all of the unintended consequences that will come from such a massive overhaul of our health care system.

But without being able to pass judgment on the ultimate merits of the law, I still believe passage of the ACA was a bad idea because doing so violated two rules that should be cardinal in public policy and politics.

First, we should not undertake radical public policy changes absent a clear and present crisis. The history of this country is littered with examples of well-meaning laws that had disastrous unintended consequences. There is widespread disagreement on the effect of the ACA on the number of Americans who will be able to obtain health insurance, its impact on the economy and public budgets and the way in which medicine is practiced, even in the short term. To predict what effect it will have over the course of several decades is pure hubris.

If there is no immediate crisis, our country would be better served by less dramatic, incremental changes, followed by enough time to adequately judge the efficacy of such course corrections.

The second principle is that significant policy changes should not be undertaken when supported by a small majority. A poll last week found that a dead-even 46 percent of Americans agreed and disagreed with the Supreme Court's decision to uphold the constitutionality of the ACA. Few issues have so equally divided popular opinion. Before the court's decision, polls generally show a small majority of Americans opposed the act and only a few showed it having the support of a slim majority.

While we like to say the majority rules, our entire system is a study in restraining small majorities from imposing their will on the rest of the country. One Democrat in Congress recently told me the lesson of the ACA was that "you cannot do the big things without bipartisan support." Amen to that.

It may be decades before the tally will be in on the ACA from a public policy view. But from political perspective, the results are in. And they are not good.

President Obama and the Democrats won a significant victory in the 2008 election that allowed them to cram the ACA down the throats of about half the country that did not want it. By using so much political capital on health care, they opened themselves to the criticism that they were not concerned about the economy. But when Americans are asked the most important issue facing the country, the economy scores roughly 10 times higher than health care.

The ACA's passage unquestionably provided much of the fuel for the stunning Republican turnaround in the 2010 election. The president has maintained that as Americans learn more about the particular provisions in the legislation, its popularity will rise. And indeed, polling consistently shows that particular provisions of the ACA, such as forcing insurance companies to cover pre-existing conditions and allowing children to stay on their parents' insurance, enjoy much higher levels of support than the act does as a whole.

Of course, that begs the question of why the president did not just ask Congress to enact those provisions that had widespread support. That would have represented measured, incremental change. I dare say that if he had done so and then moved quickly to the economy, he would likely now be coasting to a comfortable re-election instead being in a virtual dead heat with Mitt Romney.